Mo1862 Illness Stigma Perception in the Eosinophilic Gastrointestinal Disorders (EGIDs)

Mo1861 Development of a Symptom-Based Activity Index for Eosinophilic Esophagitis Alain Schoepfer, Alex Straumann, Radoslaw Panczak, Claudia Kuehni, Yvonne Romero, Elisabeth Maurer, Jeffrey A. Alexander, Ikuo Hirano, Nirmala Gonsalves, Glenn Furuta, Evan S. Dellon, John Leung, Fouad J. Moawad, Margaret H. Collins, Christian Bussmann, Peter Netzer, Sandeep K. Gupta, Mirna Chehade, Seema Aceves, John M. Wo, Marcel Zwahlen, Ekaterina Safroneeva Background: Instruments assessing disease activity in adult patients with eosinophilic esophagitis (EoE) are urgently needed to provide endpoints for clinical trials and for disease monitoring in observational studies. The international Eosinophilic Esophagitis Activity Index (EEsAI) study group developed 3 instruments to assess clinical, endoscopic, and histologic activity of EoE. The clinical activity was assessed by the means of a patient-reported outcomes (PRO) instrument. Aim: To develop a PRO instrument and score based on the items that best explain the variability in patient global assessment of EoE severity (PatGA) (on a Likert scale from 0 to 10). To assess whether endoscopic and histologic findings help to explain the variability in PatGA. Methods: The EEsAI PRO instrument assesses, among others, dysphagia characteristics, including dysphagia due to foods with 8 distinct consistencies, the time needed to eat a meal, and behavioral adaptations to dysphagia, such as food modification and avoidance. We solicited open-ended input from patients and used a Delphi technique to elicit input from physicians to generate a set of items to include in the instruments. Patients were asked to recall symptoms and behavioral adaptations over the previous 24 hour-, 7 day-, and 30 day-periods. Linear regression and analysis of variance (ANOVA) was used to evaluate the extent to which variations in patient-reported disease characteristics explain the variability in PatGA. ANOVA was used to examine the extent to which variations in endoscopic, histologic and laboratory parameters help to explain the variability in PatGA over and above PRO items. Results: The PRO instrument was evaluated in 153 adult EoE patients (72.5% males, median age 38 years) recruited in Switzerland and in the United States. A recall period of 7 days was best suited to measure EoE severity. The following 7 PRO items explained 67% of the total variability in PatGA: frequency of dysphagia, duration of dysphagia, swallowing-associated pain, the visual dysphagia questionnaire (VDQ©, 1 item), food avoidance, modification and slow eating. The VDQ© assesses dysphagia in the context of consuming foods of 8 different consistencies. The EEsAI PRO score ranges from 0 to 100. Addition of endoscopic and histologic features into the model explained only an additional 4% of the PatGA. Conclusions: Seven PRO items can be used to assess clinical EoE symptom severity over a 7-day recall period. Endoscopic and histologic features contributed negligibly over and above PRO items. The validity of the current PRO score is currently being tested in a second independent patient group.

Mo1860 Elevated Intrabolus Pressure on High Resolution Manometry Distinguishes Fibrostenotic and Inflammatory Esosinophilic Phenotypes Steven B. Clayton, Jason M. Colizzo, Joel Richter Background: Eosinophilic esophagitis (EoE) is a chronic inflammatory disease characterized by the presence of esophageal eosinophilia (15 eosinophils or greater per single high powered field) in the clinical context of dysphagia. Two major subtypes of EoE have been described: inflammatory and fibrostenotic. Currently, there have been no studies incorporating highresolution manometry (HRM) to differentiate these two subtypes. Aim: The aim of this study was to evaluate the manometric differences within these groups. Such recognition may lead to earlier diagnosis and improved understanding of EoE pathophysiology. Methods: All patients with a confirmed diagnosis of EoE according to clinicopathologic criteria managed at the Joy McCann Culverhouse Center for Swallowing Disorders were enrolled into the study. Previous esophagogastroduodenoscopy (EGD) findings were used to differentiate patients as having either fibrostenotic or inflammatory phenotypes of EoE utilizing endoscopic criteria developed by Hirano et al. We retrospectively analyzed HRM using the Chicago classification guidelines in EoE patients to identify abnormal motility patterns in inflammatory and fibrostenotic subtypes of EoE. Results: A total of 15 patients with confirmed EoE underwent HRM. Demographic analysis of the study group revealed a mean age of 43 years (26-65 yr) with 53% males and 47% females. Out of the 15 patients, 8 were fibrostenotic and 7 were inflammatory phenotypes. When the two groups were analyzed for manometric abnormalities, there were three abnormalities in the fibrostenotic group (1 jackhammer esophagus, 1 weak peristalsis, and 1 esophageal outflow obstruction) and two in the inflammatory group (1 hypertensive LES and 1 weak peristalsis). Chi squared comparison of the two groups did not reveal a statistical significance (p=0.71). However, 8/15 (53%) of EoE patients were found to have increased intrabolus pressure defined as > 17mmHg averaged for 10 liquid swallows. The fibrostenotic group displayed an overall average IBP of 22.2 mmHg and the inflammatory group demonstrated an average IBP of 14.12 Unpaired students t-test found a statistical significance (p=0.0261) between the groups. Conclusion: Elevated intrabolus pressures has been associated with functional esophageal outflow and dysphagia. The fibrostenotic EoE group demonstrated an IBP that was significantly higher than that of patients with the inflammatory type. Therefore, an elevated intrabolus pressure on HRM distinguishes fibrostenotic and inflammatory EoE phenotypes. An increased IBP likely has a causative role in dysphagia symptoms and food-bolus impactions in patients with EoE.

Mo1862 Illness Stigma Perception in the Eosinophilic Gastrointestinal Disorders (EGIDs) Tiffany Taft, Laurie Keefer Introduction: Many chronic illnesses are subject to stigma, including the irritable bowel syndrome and inflammatory bowel diseases. Perceived stigma (PS), or belief that others hold negative attitudes toward oneself or a disease, is negatively implicated in several patient outcomes including treatment adherence, psychological functioning, and health related quality of life (HRQOL). We sought to investigate if patients with EGIDs experience PS and understand its relationship to these outcomes. Methods: Participants were recruited via patient organizations and social media, and completed a series of questionnaires. Screening questions established an EGID diagnosis. Eligible participants completed the Perceived Stigma Scale for IBS (modified for EGIDs) which measures stigma from significant others (SOs) and health care providers (HCPs), the NIH-PROMIS anxiety and depression scales, impact of illness scale, eosinophilic esophagitis (EoE) quality of life scale for adults, and demographic and clinical information. Results: 110 participants completed the study; 75% had EoE. Mean diagnosis duration was 3.8 years with self-ranked mean symptom severity 6.7 (out of 10). The majority of the sample was white (94%), female (80%), married (55%), and college educated (64%) with a mean age of 36.9 years. PS did not differ by race, age, diagnosis, or EGID severity. Females reported more PS than males from both SOs (p=0.007) and HCPs (p=0.03). Being more recently diagnosed was correlated with increased PS from SOs (r= -0.20, p=.03). PS from SOs significantly correlated with negative beliefs in treatment efficacy (r= -0.36, p=.000), less controlled symptoms (r= -0.22, p=.02), and increased expectations of EGID symptoms (r= 0.23, p=.02); similar relationships existed for PS from HCPs (r= -0.43, p=.000; r= -0.26, p=.006; r= 0.30, p=.001, respectively). Additionally, patients experiencing PS from HCPs were less likely to adhere to dietary treatment (r= -0.25, p=.02) and report a more negative relationship with their physician (r= -0.30, p=.001). PS was associated with poorer HRQOL (r=0.46), greater illness impact (r=0.53), and increased depression (r=0.52) and anxiety (r=0.55) (all p=.000). Conclusions: This is the first study to evaluate PS in the EGIDs. We found that women and patients more recently diagnosed report more PS, and PS is related to several patient outcomes. Specifically, PS from SOs and HCPs is correlated with poorer EGID symptom control, greater expectations for symptom flare ups, and a negative view of treatment efficacy. PS from HCPs contributes to decreased dietary treatment adherence and a poorer patient-physician relationship. HRQOL and psychological functioning are also negatively impacted by PS. Future research into the nature of EGID stigma is warranted. Mo1863 Does Dietary Treatment for Eosinophilic Gastrointestinal Disorders Impact Health Related Quality of Life? Tiffany Taft, Laurie Keefer Introduction: Health related quality of life (HRQOL) is a widely studied construct in the chronic illness literature and is an important consideration in patient reported outcomes. To date, very few studies evaluate HRQOL in the EGIDs. Dietary treatment is commonly used to manage these conditions and may pose significant challenges for patients. This study

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AGA Abstracts

AGA Abstracts

histological remission of EoE on their elimination diet. See Table. Conclusions: TTG antibodies are elevated in a subset of pediatric patients with EoE in whom celiac disease is excluded histologically and on genotyping, in some cases more than 10xULN. Some of these patients appear to have wheat as a trigger for their EoE. We propose that elevated TTG may be a seromarker for non-celiac wheat or gluten trigger for EoE. This finding and the mechanisms that may underlie it warrant further investigation. Our findings also support the need for endoscopy and pan-biopsy including esophagus and duodenum in all patients in whom coeliac disease is suspected. 1. Thompson JS, Lebwohl B, Reilly NR et al. Increased incidence of eosinophilic esophagitis in children and adults with celiac disease. J. Clin. Gastroenterol. 2012; 46, 6-11. Eosinophilic esophagitis (EoE) and tissue transglutaminase (TTG) antibodies